An ankle fracture is a break in one or more of the bones that make up the ankle joint—most commonly the fibula (outside bone) and sometimes the tibia (inside bone). These injuries often occur with twisting mechanisms during sports, falls, or accidents.

In many active patients and unstable injuries (such as Weber B and Weber C fractures), surgery is recommended to restore alignment and stability. This typically involves a plate and screws on the fibula, and sometimes additional stabilization of the syndesmosis (ligament between the tibia and fibula) or repair of the deltoid ligament on the inside of the ankle.

The goal of surgery is simple:

• Restore alignment of the ankle joint 
• Stabilize the bones and ligaments 
• Allow early motion and predictable healing 
• Reduce the risk of arthritis long-term 

Even small shifts in alignment can significantly affect long-term outcomes, especially in athletes.

• You will be in a splint 
• No weight-bearing on the operative leg 
• Elevation is critical to control swelling 
• Focus on wound healing 

• Transition into a walking boot 
• Gradual progression of weight-bearing 
• Begin gentle ankle motion 

(Occasionally we will use a "slow down" plan which consists of NON-WEIGHTBEARING for a total of 6 weeks and a possible cast.  Check with your physician for the specific plan for your injury - see the slow down plan for details)

• Transition out of the boot into a brace or supportive shoe 
• Begin strengthening and more functional movement 

• Advance activity as tolerated 
• Start higher-level rehab 

• Return to sport (varies based on injury severity and progress) 

Not all ankle fractures are the same. Recovery depends on:

• Severity of fracture 
• Syndesmotic injury (high ankle component) 
• Soft tissue damage 
• Cartilage injury 
• Patient goals (daily activity vs high-level sports) 

Normal:

• Swelling (can last several months) 
• Stiffness 
• Mild discomfort with activity 

Not normal:

• Increasing pain 
• Drainage or redness 
• Fevers 
• Sudden loss of function 

Ankle Fracture ORIF (Weber B / Weber C)
(General guideline – individualized based on injury and intraoperative findings)

Goals

• Protect surgical repair 
• Allow soft tissue healing 
• Control swelling 

Weight-bearing

• Non-weight-bearing with crutches/scooter 

Immobilization

• Posterior splint 

Rehabilitation

• Elevation above heart (most important) 
• Toe motion 
• Quad sets and straight leg raises 
• Core and upper body conditioning 

Goals

• Restore gentle ankle motion 
• Begin controlled weight-bearing 
• Protect fixation 

Weight-bearing

• Progress from partial → full weight-bearing in boot (as tolerated) 

Immobilization

• CAM boot 

Rehabilitation

• Active and passive ankle ROM (avoid aggressive stretching) 
• Alphabet exercises 
• Seated heel raises (light) 
• Gentle theraband work (plantarflexion/dorsiflexion early, inversion/eversion later) 

Precautions

• Avoid high-impact activity 
• Avoid rotational stress if syndesmotic injury present 

Goals

• Normalize gait 
• Restore strength 
• Improve proprioception 

Weight-bearing

• Full weight-bearing in regular shoe with brace 

Rehabilitation

• Progress strengthening (calf raises, bands, closed-chain exercises) 
• Balance training (single-leg stance → unstable surfaces) 
• Stationary bike, elliptical 
• Begin light functional movement 

Goals

• Restore power, agility, and endurance 
• Prepare for return to sport 

Rehabilitation

• Plyometrics (progress gradually) 
• Sport-specific drills 
• Running progression (if appropriate) 

Return to Activity

• Typically around 4 months for many patients 
• High-level athletes may take longer depending on injury severity 

• Pain-free full weight-bearing 
• Near-normal ankle range of motion 
• Strength ≥90% of opposite side 
• Ability to perform single-leg hop and agility drills without pain 
• Cleared by physician and physical therapy 

Recovery from an ankle fracture is a process—not an event. The surgery fixes the bone, but rehab restores function.

The biggest mistakes patients make:

• Doing too much too early 
• Not controlling swelling 
• Skipping rehab 

If you stay consistent and follow the plan, most patients can return to high levels of activity.